Advanced Age Is No Deterrent to Quality-of-Life Benefits of Epilepsy Surgery
Older adults who undergo epilepsy surgery reap long-term quality-of-life benefits comparable to those of their younger counterparts, finds a large Cleveland Clinic study.
Older adults who undergo surgery for drug-resistant epilepsy reap long-term quality-of-life benefits comparable to those of their younger counterparts. So found a study of more than 400 adults who underwent epilepsy surgery at Cleveland Clinic over a period of nearly a decade.
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The study, which includes the largest quality-of-life dataset in patients with drug-resistant epilepsy undergoing surgery at age 60 or older, was published in Epilepsy & Behavior (2020 Dec;113:107574).
“Our findings indicate that epilepsy surgery should be considered for appropriate patients regardless of their age,” says Cleveland Clinic epileptologist Vineet Punia, MD, MS, lead author of the study. “Older adults and the elderly are just as likely as younger adults to report feeling better physically and mentally a year or more after surgery.”
Although epilepsy surgery is the standard of care for drug-resistant focal epilepsy, older and elderly adults are often passed over for consideration. Many doctors assume that seizure control will have less of an impact on patients who may be better adjusted to their lifestyle or may no longer need to work or drive. But literature is scarce on how aging actually affects quality of life in patients with drug-resistant epilepsy, and the impact of epilepsy surgery on quality of life in different age groups had not been well explored prior to this study.
Adults who underwent epilepsy surgery at Cleveland Clinic from January 2008 through October 2017 were included. All had taken the Quality of Life in Epilepsy 10 (QOLIE-10) survey before surgery and at a follow-up appointment at least one year after surgery. This validated survey includes general and epilepsy-specific domains including memory, mood, energy, driving, social and work limitations, and overall quality of life.
To make its cohorts comparable to earlier literature studies and to facilitate conversations with patients, the study separately analyzed patients older and younger than age 50, as well as older and younger than age 60.
Overall, 416 patients were analyzed, with the following profile:
Of the 416 patients, 100 (24%) were 50 years or older, and 30 (7%) were 60 years or older. Pre- and post-surgery seizure frequencies were similar among the cohorts.
Key findings of the analysis included the following:
In addition, two separate linear models were run to adjust for age at epilepsy onset and duration of epilepsy. Regardless of how the data were analyzed, age at surgery was not related to QOLIE-10 outcomes.
Dr. Punia emphasizes two major takeaways from the study:
“Epilepsy surgery is a highly effective therapy that is often needlessly underutilized in older patients,” concludes Dr. Punia. “This study can reassure neurologists that quality of life in well-selected older adults and the elderly stands to benefit as much as it does in their younger counterparts.”